Open versus percutaneous release of a1 pulley in diabetic trigger finger: a randomized control trial

Stenosing tenosynovitis or trigger finger is a common cause of hand pain and disability.Its prevalence is higher in the diabetic population. The mainstay of treatment consists ofsurgical release of the A1 pulley, either open or percutaneous. The present study attempts to compare the outcomes and complications of conventional open versus percutaneous release, in patients with diabetes mellitus. Material and Methods: In total, 69 patients (69 digits) withchronic diabetes mellitus (38 insulin- dependent and 31 non-insulin dependents, with an average age 48 years old) were treated for trigger finger between 2014-2019). The mean duration of symptoms was 6 months. All patients had failed conservative treatment. The digits were graded accordingto severity of symptomsby using the Quinnel classification. There were 22 grade IIfingers(31,9%), 28 grade III fingers (40,6%), and 19grade IV fingers (27,5%) [8 locked in extension and 11 in flexion]. Thirty-seven patients were treated with the open technique and 32 with the percutaneous technique. Postoperatively, the patients received follow-up visits at 2 weeks and 6 months. Results: The outcome was assessed using the questionnaire of Gilberts and Wereldsma and documenting the complications and satisfaction rate. The overall complication rate was 16.2% in the open technique group and 15.6% in the percutaneous group, with the most commoncomplications in both groups being postoperative pain on the surgical site. In the open technique group, 21 patients were very satisfied patients after treatment (56.76%), 13 were satisfied (35.14%) and 3 patients (8.1%) were unsatisfied with the surgical result. Inthe percutaneous technique group, there were 19 very satisfied patients (59.37%), 11 satisfied (34.37%), and 2 dissatisfied (6.26%). Conclusion: This study highlighted the effectiveness of both techniques; however, the percutaneous technique has the advantages of lower cost and the avoidance of wound complications.